Use of intravenous immunoglobulin in neonates at a tertiary academic hospital: a retrospective 11‐year study

Lieberman, Lani; Spradbrow, Jordan; Keir, Amy; Dunn, Michael; Lin, Yulia; Callum, Jeannie

doi:10.1111/trf.13721

Cited by 10 publications

(7 citation statements)

References 36 publications

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“…In a study done by Liberman et al, 37 neonates received IVIG over a 11-year period from 2003 to 2013 in a Canadian Tertiary care hospital which has on an average 4200 deliveries per year giving it a usage rate of around 0.08%. 5 The non-availability during yester years, the relatively high cost and the timely availability in current period, treating team decision are factors that would have influenced IVIG use.…”

Section: Discussionmentioning

confidence: 99%

“…3 It was also reiterated by the Cochrane review in 2015 by Ohlsson A et al, In coherence with increased availability of IVIG world-over, an increased usage in neonates is being noted, though its utilisation has not been investigated or audited thoroughly. 4,5 This study was planned to put light of IVIG usage in our hospital in the intramural neonatal unit. The objective of this study was to describe the usage pattern and indications for IVIG and its outcome in a state-run tertiary care NICU.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical usage of intravenous immunoglobulin in neonates in a tertiary care centre: a retrospective observational study

Ghalige

Vaideeswaran

Mangalabharathi

2019

Int J Contemp Pediatr

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Background: Intravenous Immunoglobulin (IVIG) is a blood product manufactured from pooled plasma. With increasing availability, an increased usage in neonates is being noted, though its utilisation has not been audited thoroughly. The objectives of this study are to describe the usage pattern and indications of IVIG and its outcome in a state-run tertiary care NICU.Methods: This retrospective observational study was carried out at the inborn unit of Department of Neonatology, Madras Medical College, Chennai on a cohort of neonates who received IVIG over 3.5 years from January 2016 to June 2019. Data was collected from drug register, neonatal case records, exchange transfusion register and death register.Results: Our study cohort had 55 neonates who received IVIG over 3.5 years. Indications for IVIG usage were Rh-alloimmunisation (23), ABO-alloimmunisation (7), prophylaxis of perinatal varicella (20), and other immune thrombocytopenia (5). Among 30 neonates with ABO-/Rh-incompatibility, 11 required exchange transfusion (ET). ET rates have shown a decreasing trend during this period. 2 babies with Rh-immunisation and Hydrops expired. None of the babies given prophylaxis for perinatal varicella manifested the disease. Neonates treated for immune thrombocytopenia were successfully discharged.Conclusions: This study shows the IVIG usage pattern in a tertiary care neonatal unit. In neonates with Hemolytic disease due to Rh-/ABO-alloimmunisation treated with IVIG, a reduction in rates of exchange transfusion has been noted. IVIG is being used increasingly for prophylaxis of perinatal varicella and immune related thrombocytopenia with promising benefits. It is prudent to have SOPs for IVIG administration with standardised issue and transfusion forms for documentation to regulate its judicious use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical usage of intravenous immunoglobulin in neonates in a tertiary care centre: a retrospective observational study

Ghalige

Vaideeswaran

Mangalabharathi

2019

Int J Contemp Pediatr

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“…The 2004 AAP guidelines state that if the maternal blood group is O (+), it is an option to test the cord blood for the infant's blood type and to perform a DAT, but it is not required to do so provided there is appropriate surveillance [2]. Recent studies by our group and others support eliminating routine blood typing and DAT measurement in neonates born to blood group O (+) mothers [5][6][7][8]. We found that neonates who were blood group A or B and born to mothers of group O (+) (and thus were at some risk for ABO hemolytic disease) did not have a higher incidence of severe neonatal hyperbilirubinemia than did neonates of blood group O who were born to group O (+) mothers (and thus were at no risk for ABO hemolytic disease).…”

Section: Eliminating Routine Blood Typing and Dat Testing For Neonatementioning

confidence: 99%

“…In some nurseries, serum bilirubin is used to screen for hyperbilirubinemia and in others transcutaneous bilirubin (TcB) is used [4]. Some hospitals routinely perform blood typing and direct antiglobulin testing (DAT) on all neonates born to women of blood group O [5][6][7][8]. Recently, a series of publications exposed possible adverse effects of well-baby phototherapy and challenged the perception that neonatal phototherapy is totally benign [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Improving the Bilirubin Management Program in the Newborn Nursery: Background, Aims, and Protocol

et al. 2020

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Background: Practices to detect and manage hyperbilirubinemia in newborn nurseries are highly variable. American Academy of Pediatrics guidelines in 1999, 2004, and 2009 have generated, perhaps unintentionally, divergent practices that might not all be of equivalent value. Evidence-based progress is needed to define less invasive, less expensive, uniform, and safe methods to reduce ER visits and hospital readmissions for jaundice treatment and bilirubin encephalopathy. Objectives: This research briefing is intended to inform readers of a new prospective quality improvement program aimed at testing the value of specific changes in newborn nursery hyperbilirubinemia detection and management. This new program includes predetermined means of assessing those specific changes, which relate to diagnosis, safety, outcomes, and cost. Methods: In this briefing, we present the perceived problems in our present bilirubin management system, as voiced by stakeholders. We report our proposed means to test minimization of those problems utilizing already acquired data on approximately 400,000 well babies in the Intermountain Healthcare system of hospitals in the western USA. We then describe our methods of assessing specific outcomes in a pre-versus postpractice change analysis. Results and Conclusions: The University of Utah Newborn Nursery will implement a quality improvement project in bilirubin management during 2020 to test the feasibility and effectiveness of several changes to our current bilirubin management program. We maintain that the improved understanding generated by this project will be a step toward new evidence-based strategies for reducing ER visits and hospital readmissions for jaundice treatment and preventing bilirubin encephalopathy.

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“…Despite IVIG is thought to reduce the rate of hemolysis and consequently the need for exchange transfusions in theory, the conclusions of the previous research on the use of IVIG in ABO HDN are controversial in recent years [ 5 ]. Furthermore, as a kind of blood product, the use of IVIG has been associated with significant morbidity in neonates [ 6 , 7 ]. Therefore, additional clinical research evaluating IVIG in ABO HDN need to be performed before definitive conclusions can be drawn.…”

Section: Introductionmentioning

confidence: 99%

Intravenous immunoglobulin G in the treatment of ABO hemolytic disease of the newborn during the early neonatal period at a tertiary academic hospital: a retrospective study

et al. 2021

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Objective To evaluate the efficacy and safety of intravenous immunoglobulin G (IVIG) in infants with ABO hemolytic disease of the newborn (HDN). Methods Infants with moderate-to-severe ABO HDN during early neonatal period (<7 days) at our hospital in 2017 were included in this retrospective study. Patients treated with IVIG and phototherapy were classified as the IVIG group, and those who only received phototherapy were classified as the phototherapy only group. Results Forty-six patients were classified into the IVIG group and 68 other patients were classified into the phototherapy only group. There was no significant difference in duration of phototherapy, hospitalization periods, needs for exchange transfusion, transfusions, and incidence of bilirubin-induced neurological sequelae between these two groups (P = 0.20, 0.27, 0.65, 0.47, 0.78, respectively). Conclusion It seems unnecessary to expose neonates to IVIG in moderate-to-severe ABO HDN when the available data show no appreciable benefits.

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Use of intravenous immunoglobulin in neonates at a tertiary academic hospital: a retrospective 11‐year study

Cited by 10 publications

References 36 publications

Clinical usage of intravenous immunoglobulin in neonates in a tertiary care centre: a retrospective observational study

Clinical usage of intravenous immunoglobulin in neonates in a tertiary care centre: a retrospective observational study

Improving the Bilirubin Management Program in the Newborn Nursery: Background, Aims, and Protocol

Intravenous immunoglobulin G in the treatment of ABO hemolytic disease of the newborn during the early neonatal period at a tertiary academic hospital: a retrospective study

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